The Immunocompromised Patient Flashcards
What is immune deficiency?
B cell or humoral deficiency affecting AB production
T cell or mediated immunity deficiency
Mixed deficiency
What is humoral immunity?
AB produced by plasma cells.
What are AB’s and how many types are there?
AB = antibody.
They are immunoglobulins. 5 types : G, A, M, E, D
(A is secreted by exocrine glands - parotid and submandibular)
What is cell mediated immunity?
T lymphocytes - activated - produce lymphokines - modulate activity of macrophages - important in defence against myobacteria, fungi and viruses.
T lymphocytes either assist (T helper) or moderate (T suppressor) AB production
What are the causes of immune deficiency?
CONGENITAL (RARE) : Cyclic neutropoenia - ulcers and red gingivae, no neutrophils Wiskott - Aldrich Syndrome - problem making IgM and IgE and platelets so can be thrombocytopoenic too ACQUIRED : Corticosteroid therapy Malignancy Chemo / bone marrow / organ transplant Viral
What does corticosteroid therapy cause?
Predisposition to diabetes mellitus Cushings appearance Increased risk fungal infections Hypertension Osteoporosis Adrenal suppression Gastric ulceration
What are some oro - dental problems associated with steroid therapy?
Candida
Delayed healing
Osteoporosis
What causes a steroid crisis?
Suppression
Hypo-adrenal crisis due to stress, shock, low BP, GA
Who is given chemotherapy?
Pts who may have received radiotherapy
Pts with previous surgical intervention to remove malignancy
Pts with malignancy of haemopoetic tissue or inborn errors of cell metabolism prior to bone marrow transplant
What can cytotoxic agents cause if they affect bone marrow?
Leukopoenia
Neutropoenia
Thrombocytopoenia - causing increase in bleeding time
Anaemia
What can present orally during chemo?
Severe mucositis
Oral ulceration
Opportunistic infections - candida, pseudomonas, herpes
How do we manage chemo patients?
Need to know FBC
Antibiotic prophylaxis - amoxiciliin 3g, clindomycin 600mg
What is HIV?
Progressive disease in which regulation and function of immune system is impaired.
Reduction in the number of CD4+ helper cells (hard to regain)
What is used as the marker of HIV progression?
CD4+ count
Health = >600
Initial = 400-600
Severe = 200
Is HIV treatable, using what?
Yes it is treatable, using antiretrovirals :
nucleoside analogues
protease inhibitors
